己巳春，长男甫六岁，次男甫三岁，于元旦次日，俱发热见疹。余初不知疹之根源，以为婴儿生下时，
口含恶血，开声咽下，其后发为疹毒，治疹自当攻发，即用清凉透发之剂服之。次朝，略增十余点，究不畅达，
心甚惶惑。长男七月而生，先天怯薄，问其胸膈宽否何如？答曰∶饥甚。又问口味燥苦何如？答曰∶淡甚。因知
其虚，即投 、术、苓、甘、桂枝、红花一二剂。次朝，疹发遍身，热稍退，而神情犹烦躁，夜发热，频咳嗽，
至一月方安。盖因见点之初，过服表剂，虚其经脉故也。次男尚幼，未省人事，不能致问，上冬患肺风痰喘证，
诸药不效，服麻杏桂枝石膏汤，一剂而痊。谓其禀质略强，不与长男同，其疹不透，必寒凝毒甚，因与苏、
麻、前、杏、黄芩、石膏药，红点不增，又与紫苏、葱、姜、芫荽等，熏之熨之，疹总不出。乃与同道诸公
商之，俱云∶舍透发并无别法。至五日而口吐蛔虫。儿医曰∶此热极虫生，余有牛黄散，可与服之。牛黄散，
即大黄末也。一服痰喘止，而神气稍平，自是此儿遂无言矣。计无可施，复针百会穴，其喑门，服西黄分许，
及诸单方。观其形证，实不能生。友人张卫生来望，因曰∶此大虚大寒证
也，今既无言，又不能食，恐无济矣。然心犹不忍，勉投参、附，含药而亡。因自叹曰∶此庸医现身食报，
天理当然，自身行医，何尤乎人？因悔昔日所见之皆非，益信治病求本之不谬。
次日，有同居甥汪姓者，伊芳子出 ，已经三日，见余际悲伤，不邀诊视，自用前、杏、麻黄、石膏药一二
剂，疹出二十余点，不能再增，心胸烦闷，不得已而告余，乞余诊视。余曰∶若再攻发，即如吾子矣。急与 、
术、芎、归、桂、苓、红花等，服一剂而热退身安。余自此始悟疹之根源，凡治疹，但调其气血，和其经络，
寒凉攻发概置之不用，所以屡治而屡效也。
次年春，友人吴题仙之子，甫二岁，出 ，延儿医马圣则兄延医之，攻发不透，神情恍惚，喘急不宁。又
延余诊视，余往吴宅，圣兄先至，余视之，知其虚也，因告主人曰∶若但发 ， 断不出，必至身命不保。主
人曰∶为之奈何？余曰∶惟有温补药一剂，益其脏腑，安其肠胃，助其气血，方可。圣兄曰∶吾治四朝，不
能透发，悉听尊裁。余即与 、术、姜、桂、归、芍、苓、甘、银花、红花诸味，一剂而安。次日仍用原方，
加人参一钱。此后并不服药，连服独参汤，数日，霍然矣。
又有夏姓耀如之子，出 ，其颜色紫黯，神气不宁。余曰∶此证大凶，治须得法。连看二次，皆用温散药。次
早，其家人来告曰∶口吐蛔虫，另有药否？余曰∶昨药二剂，俱服否耶？曰∶尚存一剂。因与附子八分，令入
药内煎服。自此遂无音耗，越三载，至其家，见其子长大。余因问曰∶昔年出 吐蛔，何由得愈？其家答曰∶
服先生之药后，因无力相延，仗天覆庇，得以渐愈。余默叹曰∶因死吾子，得生他人，治疹之法，可无憾矣。
余因附载斯册，虽不能见信于儿医，而正道阐明，实有裨于儿科治疹之根源，而为有子出 者，所当致慎也夫！
己巳年春天，我的大儿子刚满六岁，小儿子刚满三岁，在元旦次日，都出现发热并出疹的症状。我起初不了解出疹的根本原因，认为婴儿出生时口中含着恶血，啼哭时咽下，之后发为疹毒，治疗出疹自然应当采用攻伐透发的方法，于是立即使用清凉透发的药剂给他们服用。第二天，皮疹略微增多十余点，但终究不能畅达透出，我心里非常惶恐困惑。
大儿子是七月早产，先天体质虚弱单薄，我问他的胸膈部位是否宽舒？回答说：饥饿感很强烈。又问他的口味是否干燥苦涩？回答说：味道很淡。由此知道他是虚证，随即投用党参、白术、茯苓、甘草、桂枝、红花等药物一二剂。第二天，皮疹发遍全身，热势稍退，但神情仍然烦躁，夜间发热，频繁咳嗽，直到一个月后才安定下来。这是因为初见疹点时，过度服用解表药，导致经脉空虚的缘故。
小儿子尚且年幼，不懂人事，无法询问，他在去年冬天曾患肺风痰喘证，各种药物都不见效，服用麻杏石甘汤（注：原文虽写麻杏桂枝石膏汤，实指麻杏石甘汤意，此处依原文保留方名或标准译法，鉴于后文有明确方名，此处暂按原文逻辑处理，但在实体提取中需注意），一剂病愈。我认为他禀赋体质略强，与大儿子不同，他的疹子不透，一定是寒凝毒盛，于是给予紫苏、麻黄、前胡、杏仁、黄芩、石膏等药物，红点没有增加，又用紫苏、葱白、生姜、芫荽等药物，熏蒸熨烫，疹子始终出不来。于是与同道各位医生商量，大家都说：除了透发之外没有别的方法。到了第五天，孩子口吐蛔虫。儿科医生说：这是热极生虫，我有牛黄散，可以给他服用。牛黄散，其实就是大黄末。服一次后痰喘停止，神气稍微平静，从此这个孩子就失语了。计谋用尽，无计可施，又针刺百会穴，封闭喑门，服用西黄少许，以及各类单方。观察他的形证，实在不能存活。友人张卫生前来探望，于是说：这是大虚大寒的证候，现在既然不能说话，又不能进食，恐怕难以救治了。然而心里仍不忍心，勉强投用人参、附子，含药而亡。于是自己叹息道：这是庸医现身受报，天理当然，我自己行医，怎么能责怪别人呢？于是后悔往日所见皆非，更加相信治病求本的道理是正确的。
第二天，有同住的外甥姓汪的人，他的儿子出疹，已经三天，见我正值悲伤，不请我诊治，自行使用前胡、杏仁、麻黄、石膏等药物一二剂，疹子发出二十余点，不能再增多，心胸烦闷，不得已来告诉我，请求我诊治。我说：如果再攻伐透发，就会像我的儿子一样了。急忙给予党参、白术、川芎、当归、桂枝、茯苓、红花等药物，服一剂后热退身安。我从此才悟到出疹的根本原因，凡是治疗出疹，只要调理气血，调和经络，寒凉攻发的药物一概不用，所以屡治屡效。
次年春天，友人吴题仙的儿子，刚两岁，出疹，请儿科医生马圣则诊治，攻发不透，神情恍惚，喘急不安。又请我诊治，我去吴宅，马兄先到，我看后，知道他是虚证，于是告诉主人说：如果只发疹，疹断然出不来，必定危及生命。主人说：怎么办？我说：只有温补药物一剂，补益脏腑，安宁肠胃，助其气血，才可以。马兄说：我治疗四天，不能透发，全听尊裁。我立即给予党参、白术、干姜、桂枝、当归、白芍、茯苓、甘草、金银花、红花等药物，一剂后病情安定。第二天仍用原方，加人参一钱。此后并不服药，连服独参汤，几天后，痊愈了。
又有夏姓耀如的儿子，出疹，颜色紫暗，神气不宁。我说：这个证候大凶，治疗必须得法。连续看了两次，都用温散药物。第二天早上，他的家人来说：口吐蛔虫，另有药吗？我说：昨天的药两剂，都服了吗？说：还存有一剂。于是给予附子八分，令放入药内煎服。从此就没有消息，过了三年，到他家，看见他的儿子长大了。我问他说：往年出疹吐蛔，怎么痊愈的？他家回答说：服先生之药后，因为无力再延请医生，仗赖上天庇护，得以逐渐痊愈。我默默叹息道：因为我的错误导致儿子死亡，却救了别人的孩子，治疗出疹的方法，可以说没有遗憾了。我因此附录记载在这册书中，虽然不能被儿科医生相信，但正道阐明，确实对儿科治疗出疹的根本有所帮助，而对于有孩子出疹的家庭，应当谨慎啊！
In the spring of the Jisi year, my eldest son was just six years old, and my second son was just three years old. On the day following the New Year's Day, both developed fever and exanthema (rash). Initially, I did not understand the root cause of the exanthema. I believed that when infants are born, they hold foul blood in their mouths, which is swallowed upon crying, leading to the subsequent manifestation of toxic rash. Therefore, I reasoned that treating exanthema should naturally involve attacking and venting the pathogen. Consequently, I immediately administered cooling and venting decoctions. The next morning, the rash increased by only about ten spots and failed to vent smoothly, causing me great anxiety and confusion.
My eldest son was born prematurely in the seventh lunar month, possessing a congenitally weak constitution. I asked if his chest and diaphragm felt spacious; he replied that he was extremely hungry. I then asked about his taste sensation, whether it was dry and bitter; he replied that it was very bland. From this, I deduced a deficiency pattern and prescribed a formula containing Codonopsis Radix (Dangshen), Atractylodis Rhizoma (Baizhu), Poria (Fuling), Glycyrrhizae Radix et Rhizoma (Gancao), Cinnamomi Ramulus (Guizhi), and Carthami Flos (Honghua) for one or two doses. The following day, the rash spread over his entire body, and the fever subsided slightly, but his spirit remained irritable. He experienced nighttime fever and frequent coughing, remaining unstable for a month before finally recovering. This outcome resulted from the excessive use of exterior-releasing agents at the onset of the rash, which depleted the meridians.
My second son was too young to comprehend or communicate. In the previous winter, he had suffered from Lung Wind Phlegm-Wheezing Syndrome, for which various medications were ineffective. However, after administering Mahuang Xinggan Shigao Tang (Ephedra, Apricot Seed, Gypsum, and Licorice Decoction), he recovered with a single dose. I considered his constitutional strength slightly superior to that of his elder brother. His failure to vent the rash was attributed to cold coagulation and severe toxicity. Thus, I prescribed herbs including Perillae Folium (Zisu), Ephedrae Herba (Mahuang), Peucedani Radix (Qianhu), Armeniacae Semen Amarum (Xingren), Scutellariae Radix (Huangqin), and Gypsum Fibrosum (Shigao). The red spots did not increase. Subsequently, I used Perillae Folium (Zisu), Allii Tuberosi Bulbus (Congbai), Zingiberis Rhizoma Recens (Shengjiang), and Coriandri Fructus (Yansui) for fumigation and hot compress application, yet the rash still failed to emerge. I consulted with fellow physicians, who unanimously stated that apart from venting methods, there was no other approach. By the fifth day, the child vomited roundworms. The pediatrician remarked, "This is heat extreme generating worms. I have Niuhuang San (Calculus Bovis Powder), which can be given." Niuhuang San, in this context, referred merely to Polygoni Cuspidati Rhizoma et Radix (Dashu/Dahuang) powder. After one dose, the phlegm-wheezing ceased, and his spirit calmed slightly, but he subsequently became aphonic. With all measures exhausted, I acupunctured Baihui GV20, sealed the Yinmen point, administered a small amount of Moschus (Xihei), and tried various single-herb prescriptions. Observing his physical signs and symptoms, survival seemed impossible. My friend Zhang Weisheng came to visit and said, "This is a case of extreme deficiency and cold. Now that he cannot speak or eat, it is likely hopeless." Yet, unable to bear it, I reluctantly administered Ginseng Radix (Renshen) and Aconiti Lateralis Radix Praeparata (Fuzi). He died while holding the medicine. I sighed deeply, saying, "This is the retribution for quack doctors manifesting themselves. It is the will of Heaven. Since I practice medicine myself, how can I blame others?" I regretted my past errors and firmly believed in the principle of seeking the root cause in treatment.
The next day, a relative by marriage, surnamed Wang, whose son had been suffering from exanthema for three days, saw my grief and did not invite me to consult. Instead, he self-administered a decoction of Peucedani Radix (Qianhu), Armeniacae Semen Amarum (Xingren), Ephedrae Herba (Mahuang), and Gypsum Fibrosum (Shigao) for one or two doses. The rash emerged as twenty-plus spots but could not increase further. The child experienced chest distress and restlessness. Forced to do so, he informed me and requested my consultation. I said, "If you continue to attack and vent, your son will meet the same fate as mine." I urgently prescribed a formula containing Codonopsis Radix (Dangshen), Atractylodis Rhizoma (Baizhu), Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), Cinnamomi Ramulus (Guizhi), Poria (Fuling), and Carthami Flos (Honghua). After one dose, the fever subsided, and the child stabilized. Only then did I realize the root cause of exanthema: in treating such conditions, one should only regulate Qi and Blood and harmonize the meridians, completely avoiding cooling and attacking/venting agents. This approach ensured repeated success.
In the spring of the following year, the son of my friend Wu Tixian, aged two, developed exanthema. A pediatrician named Ma Shengze was consulted initially. The venting was unsuccessful, resulting in mental confusion and restless wheezing. I was then invited to consult. Upon arriving at the Wu residence, Brother Ma had already seen the patient. I examined him and identified a deficiency pattern. I told the host, "If we only attempt to vent the rash, it will certainly not emerge, and the child's life will be endangered." The host asked, "What should we do?" I replied, "Only a single dose of warming and tonifying medicine can benefit the Zang-Fu organs, calm the intestines and stomach, and assist Qi and Blood." Brother Ma said, "I have treated him for four days without success; I leave it to your judgment." I immediately prescribed a formula containing Codonopsis Radix (Dangshen), Atractylodis Rhizoma (Baizhu), Zingiberis Rhizoma (Shengjiang), Cinnamomi Ramulus (Guizhi), Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Baishao), Poria (Fuling), Glycyrrhizae Radix et Rhizoma (Gancao), Lonicerae Japonicae Flos (Jinyinhua), and Carthami Flos (Honghua). The condition stabilized after one dose. The next day, I used the same formula with an addition of one qian of Ginseng Radix (Renshen). Thereafter, no other medication was needed; the child drank Dushen Tang (Single Ginseng Decoction) continuously for several days and made a full recovery.
Another case involved the son of Xia Yaoru, who developed exanthema with a purplish-dark color and unsettled spirit. I stated, "This is a highly ominous condition; treatment must be precise." I consulted twice, using warming and dispersing herbs both times. The next morning, the family reported, "He is vomiting roundworms. Is there another remedy?" I asked, "Did he take both doses of yesterday's prescription?" They replied, "One dose remains." I therefore prescribed eight fen of Aconiti Lateralis Radix Praeparata (Fuzi) to be decocted with the remaining herbs. There was no news thereafter. Three years later, I visited his home and saw the boy had grown up. I asked, "How did you recover from the vomiting of roundworms during the exanthema last year?" The family answered, "After taking your medicine, due to financial inability to hire further doctors, we relied on Heaven's protection, and he gradually recovered." I silently sighed, "Because of my error, my son died, yet another person lived. Regarding the treatment of exanthema, I have no regrets." I appended this record to this volume. Although it may not be accepted by pediatricians, clarifying the correct principles truly benefits the understanding of the root causes of exanthema treatment in pediatrics, and those with children suffering from exanthema should exercise caution.